As the course of Parkinson’s progresses, symptom control by medications can start to diminish. Motor blocks (also known as freezing), balance impairments and falls become more common. Many people also experience anxiety, fatigue and depression.
Loss of confidence is common and many people tend to reduce the risk of falls and balance problems by limiting their activities.
At this stage of Parkinson’s, the physiotherapist will concentrate on aspects such as falls prevention, improvement of transfers, gait, reaching and grasping objects. This may include:
- a falls prevention programme – including training of gait and balance, posture re-education, cardiovascular fitness and practising transfer techniques
- assessment and training in the use of walking aids
- choosing proper footwear
- removing domestic hazards
- the avoidance of dual/multi tasks (it is easier for people with Parkinson’s if they concentrate on performing only one action at a time)
- management of motor blocks.
Physiotherapy and the advanced stages of Parkinson’s
In the advanced stages of Parkinson’s, the interventions described above will continue. Other strategies that the physiotherapist might use will depend to a large extent on the severity of the problems that the person is experiencing at this point. Their aim will be to maintain as much ability as possible. This may involve assisted exercises.
If the person is very disabled, their mobility may be limited and the intervention might also focus on advice to overcome some of the problems that can occur as a result of immobility, e.g. the prevention of pressure sores and contractures (chronic loss of joint movement).
